Coming off propranolol/pvcs worse on beta blockers?

[mummyofspot]

Hi everyone

Any advice would be gratefully received. I'm currently on Propranolol. Was given it 2 years ago for anxiety. I was initially on 80mg Slow release. Over the past 2 years my PVCs have become unbearable (these have without a doubt gotten so much worse on propranolol, I was hardly having any before I was on it).

Anyway my questions are, has anyone notice PVCs worse on beta blockers and has this resumed after stopping them?

I am now trying to taper off of them. I stopped the 80mg slow release and switched over to the immediate release. I'm now on 5mg x 4 times a day (so 20 mg in total). This has been ok and I am definitely feeling better in myself although today my heart has been a bit all over the place and anxiety is up today. I've just been to the drs and she said to stop completely. She said there is no issue to do this but everything I've read online says the opposite. I am very very scared of any heart symptoms and now have developed cardiophobia which is completely ruining my life.

Should also mention that I've had all the tests, holter, echo, stress MRI and have no problems with my heart (apart from the worsening PVCs).

Should I carry on tapering? Or am I low enough now (20mg per day) to just stop? How long does withdrawal last for?

Any advice/experiences would be very much appreciated.

Thank you so much.

[Cliff_G]

Hi,

Any med which slows your heart rate can (not necessarily "will") lead to an increase in PVCs. This happened with me years ago with Diltiazem, which has similar rate slowing action to beta blockers. The longer the gap is between ordinary heartbeats (e.g. at a slow heart rate), the more chance there is for the spurious PVC discharges to find a gap when the heart is no longer refractory after a normal beat, and can be restimulated early.

My experience of 30 years of this condition is that meds affect different people differently, and whilst beta blockers have their place, in some people they have these adverse effects. Definitely worth trying to continue down to zero as suggested by your GP.

Re the anxiety, having your heart mess you about can easily be a cause. Things like slow breathing and progressive relaxation can gelp a lot. Also try to learn meditation, in whatever form suits you.

Best of wishes

[mummyofspot in reply to Cliff_G]

Hi Cliff_G.

Thank you for your reply. Yes this makes sense and has definitely been my experience too. I've noticed now I'm reducing the dose, I'm getting much less frequent PVCs. I hardly had any before going on the beta blockers. I went on them for anxiety and racing heart.

I'm down to 15mg a day and so far it's not too bad. Both my cardiologist and GP said to stop them without taper, but everything I've read says do not just stop.

You are right about the anxiety, I need to learn to relax and also meditation and deep breathing!

Thank you again for taking the time to reply to me.

[PadThaiNoodles]

Many people come off beta blockers without any withdrawal effects. Of course, because they're fine, they don't post about it, while those that do have issues post about them. So the posts make it look like withdrawal issues are more widespread than they are.

Do you have anything else for anxiety (such as benzos)? If so, they might ease any extra anxiety you do get. If not, tapering might still be the best option just so it doesn't add extra stress.

FWIW, I get pretty good anxiety relief from SSRIs (I'm on escitalopram for depression & generalised anxiety disorder). I'm also on a beta blocker (bisoprolol), but I only started that after recent open-heart-surgery. I don't have any side effects from it -- my PVCs have actually decreased. Then again, that might have more to do with the fact that my valves aren't leaking all over the place anymore.

[mummyofspot in reply to PadThaiNoodles]

Hi there

Thanks so much for replying. You're right, I'd never thought of it like that! More people post when they have issues.

Dr gave me some benzos but I'm scared to take them. I've tried SSRIs in the past but they made my anxiety so bad. I'm down to 3 x 5mg on the propranolol now (wonder how much lower I should taper before stopping)?. HR is defo higher but PVCs are less. Anxiety comes and goes.

I'm glad your PVCs have reduced and that your leaky valves have been repaired :-).

Open heart surgery, that must've been scary! My dad had a triple bypass 5 years ago. He's doing amazing now!

Thanks again.

[PadThaiNoodles in reply to mummyofspot]

Before they had SSRIs, benzos were the front-line treatment for depression and anxiety. So I wouldn't be too worried about a few of them as you come off the beta blocker (and they do work).

If your Dr suggested stopping the beta blocker completely I'd be inclined to give it a try. You've got the benzos as a backup.

[mummyofspot in reply to PadThaiNoodles]

Thank you. I’m just so worried about stopping them and my blood pressure shooting up. I don’t have a chronic raised blood pressure but it does go up with anxiety. And now I’m convincing myself that the weird head/neck pressure I’m getting is due to this!

Although I guess if my Dr thought it was a problem she wouldn’t have told me to just stop!

Think I’ll take a diazepam tonight!

Thanks again!